Implementing Medication-Assisted Therapy for Substance Use Disorders in Mental Health

对心理健康中的药物使用障碍实施药物辅助治疗

• 批准号: 9414164
• 负责人: Katherine E Watkins
• 金额: $ 29.54万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-20 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9414164
• 关键词: Address; Administrator; Adopted; Adoption; Adult; Affect; Alcohol consumption; Attitude; Behavior Therapy; Behavioral; Clinic; Cost Savings; County; Development; Education; Effectiveness; Evidence based intervention; FDA approved; Focus Groups; Geography; Guidelines; Health Personnel; Health Services Accessibility; Health system; Healthcare; Homelessness; Imprisonment; Individual; Intervention; Interview; Los Angeles; Mental Health; Methods; Modeling; Morbidity - disease rate; Organizational Change; Organizational Objectives; Outcome; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Play; Population; Population Heterogeneity; Primary Health Care; Probability; Process; Provider; Readiness; Research; Resources; Risk; Role; Structure; Substance Use Disorder; Surveys; System; Testing; Treatment outcome; Underserved Population; base; cost; dual diagnosis; effective therapy; evidence base; experience; health belief; improved; improved outcome; innovation; medical specialties; medication-assisted treatment; member; mortality; opioid use disorder; peer; preference; psychologic; severe mental illness; social; theories; working group

PROJECT SUMMARY/ABSTRACT Substance use disorders (SUDs) can have devastating consequences for people with serious mental illness (SMI). SUDs can increase morbidity and mortality and are associated with higher healthcare and social costs, homelessness, and incarceration. Unfortunately, despite the availability of effective treatments, most individuals with co-occurring SMI and SUD, (COD) never receive SUD treatment--treatment that could significantly improve patient outcomes. Increasing access to SUD treatment and improving patient outcomes will require addressing both the supply of and the demand for treatment. At the system and provider level, the availability of treatment needs to be increased. At the patient level, patient demand for treatment needs to increase, by identifying and addressing patient perceptions of need for treatment and preferences. We propose to evaluate system, provider and patient-level facilitators and barriers, and then to use this information to develop an implementation strategy and toolkit to promote the use of medication assisted treatment (MAT)--the use of FDA-approved medications for SUD in combination with behavioral therapies--for people with COD receiving public mental health treatment. We focus on MAT because of its demonstrated effectiveness and cost-savings, and specialty mental health because of the relatively large role the mental health system plays in treating individuals with COD. Aims 1-3 seek to assess organizational capacity (at the system and provider level); organizational readiness (at the provider level); and perceived needs, attitudes and preferences (at the patient level) to identify barriers and facilitators. In Aim 4, we will use findings from Aims 1- 3 to guide development of the implementation strategy and toolkit, using stakeholder input and a systematic process for strategy development. By implementation strategy we mean a group of implementation interventions that will address barriers at multiple levels. By toolkit, we mean the resources providers and clinics will need to execute implementation. To conduct the research, we will collaborate with the Los Angeles County Department of Mental Health. Using a mixed methods approach, we will conduct semi-structured interviews, focus groups, and surveys with patients and providers from 8 clinics serving an ethnically and geographically diverse population. We plan to test the strategy in a subsequent R01, where we will examine how the strategy affects MAT adoption, implementation and sustainability. Our study is a first step towards increasing access to SUD treatment for a vulnerable, costly and underserved population. Our approach is innovative because we consider barriers to MAT from the system, provider, and patient perspectives simultaneously, and use this information to develop an implementation strategy that addresses both organizational supply and patient demand.

项目概要/摘要 药物滥用障碍 (SUD) 可能会给患有严重精神疾病的人带来毁灭性后果 （SMI）。 SUD 会增加发病率和死亡率，并与更高的医疗保健和社会成本相关， 无家可归和监禁。不幸的是，尽管有有效的治疗方法，大多数 同时患有 SMI 和 SUD (COD) 的个体从未接受过 SUD 治疗——这种治疗可能 显着改善患者的治疗效果。增加 SUD 治疗的可及性并改善患者的治疗效果 将需要解决治疗的供应和需求。在系统和提供商层面， 需要增加治疗的可用性。在患者层面，患者对治疗的需求需要满足 通过识别和解决患者对治疗需求和偏好的看法来增加。 我们建议评估系统、提供者和患者层面的促进因素和障碍，然后使用它 制定实施战略和工具包以促进药物辅助的使用的信息 治疗 (MAT)——使用 FDA 批准的 SUD 药物与行为疗法相结合—— 患有 COD 的人正在接受公共心理健康治疗。我们专注于 MAT，因为它已被证明 有效性和成本节约，以及专业心理健康，因为心理健康发挥着相对较大的作用 卫生系统在治疗 COD 患者方面发挥着重要作用。目标 1-3 寻求评估组织能力（在 系统和提供商级别）；组织准备情况（在提供商层面）；以及感知到的需求、态度和 偏好（在患者层面）以确定障碍和促进因素。在目标 4 中，我们将使用目标 1 的发现 - 3 利用利益相关者的意见和系统性的建议来指导实施战略和工具包的制定 战略制定的流程。实施策略是指一组实施 干预措施将解决多个层面的障碍。通过工具包，我们指的是资源提供者和 诊所需要执行实施。 为了进行这项研究，我们将与洛杉矶县心理健康部合作。使用 采用混合方法，我们将进行半结构化访谈、焦点小组和调查 来自 8 个诊所的患者和提供者为不同种族和地域的人群提供服务。我们计划 在后续的 R01 中测试该策略，我们将在其中检查该策略如何影响 MAT 采用， 实施和可持续性。我们的研究是增加 SUD 治疗机会的第一步 弱势、昂贵且服务不足的人群。我们的方法是创新的，因为我们考虑到了障碍 同时从系统、提供者和患者的角度考虑 MAT，并使用这些信息来开发 解决组织供应和患者需求的实施策略。